Promoting Health and Wellbeing of Children and Families Through Relationship Based Interventions

Welcome to my blog, which speaks to parents, professionals who work with children, and policy makers. I aim to show how contemporary developmental science points us on a path to effective prevention, intervention, and treatment, with the aim of promoting healthy development and wellbeing of all children and families.

He describes helping Ellington to calm down after a tantrum or bad scare, providing discipline and rules, and, in addition to lots of hugs and comfort, helping him learn to manage failure. These are exactly the parenting behaviors that research has shown lead to the capacity for emotional regulation, cognitive resourcefulness, resilience, and the ability to adapt to a complex social world.

The thesis of this book, whose primary focus is the education system-Tough is speaking on Thursday September 6th at the Gutman Library of the Harvard School of Education-, is that the conventional wisdom about the key to success has been misguided. Rather than focus on promoting cognitive abilities, our focus should be on development such things as gratitude, curiosity, self-control and grit, all of which are distilled into the word "character."

While Tough does not explicitly make this point, but rather demonstrates it in writing about his son, character develops in relationships. When a person has a relationship with someone who not only cares about him, but also thinks about him, understands his perspective and unique challenges, helps him calm down in the face of difficult feelings, sets limits on his behavior and trusts him enough to let him fail, he is more likely to develop the "non-cognitive skills" associated with success. He will be able to think clearly and flexibly in the face of stress.

The first chapter offers an excellent overview of the current explosion in research on toxic stress, or stress in the absence of such a secure, safe relationship. Tough refers to the ACES (Adverse Childhood Experiences) study, a huge longitudinal study that dramatically demonstrated the association between early adversity, including such things as abuse and neglect, parental mental illness and substance abuse, and family discord, with many negative health outcomes including not only mental illness but also chronic illnesses such as diabetes, asthma and heart disease.

Particularly important is the work of Alicia Lieberman, one of the pioneers in the field of infant mental health. Tough writes of Lieberman's collaboration with pediatrician Nadine Burke Harris in an innovative San Francisco based program that applies the ACES study to preventive work with children and families. Lieberman recognizes that providing a secure attachment relationship "takes a superhuman quality" in the face of poverty, uncertainty and fear. Her model of intervention works with parent and child together.

Lieberman's treatment is relatively intensive, administered in weekly sessions that can continue for as long as one year. But the principle behind it-improving children's outcomes by promoting stronger relationships between children and their parents-is increasingly in use across the country in a wide variety of interventions. And the results, when the interventions are evaluated, are often powerful.

The rest of Tough's book focuses on interventions for school age children. The implication is that these children have had stressed early relationships, but that interventions in the school setting that focus on character development may mitigate against these early experiences. He writes:

It is hard to argue with the science behind early intervention. Those first few years matter so much in the healthy development of a child's brain; they represent a unique opportunity to make a difference in a child's future. But one of the most promising facts about programs that target emotional and psychological and neurological pathways is that they can be quite effective later on in childhood too-much more so than cognitive interventions.

Tough describes successful school programs that have focused on character development. The Youth Advocate Program, or YAP, in Chicago offers an intensive mentoring program for high-risk teenagers. At KIPP (Knowledge is Power Program) in the South Bronx, where there is a curriculum designed to teach character, and even a character report card, one student describes how the teachers were devoted to him and his fellow students. " They were like my second family, in essence...that's the vibe we all ended up getting, that we were like a family."

Yet another program is OneGoal in Chicago, run by CEO Jeff Nelson:

Nelson's belief is that underperforming high-school students can relatively quickly transform themselves into highly successful college students- but that it is almost impossible for them to make that transition without the help of a highly effective teacher. OneGoal has signed a unique partnership deal with the Chicago public schools that lets the organization work directly with individual teachers...the teacher sticks with the same class for three years...And when the students are freshmen in college the teacher keeps in close touch with them...providing support and advice."

Tough shows how relationships can be stressed not only for the very poor, but also the very wealthy.

Riverdale, a private school in a very different part of the Bronx from KIPP, offers an example of wealthy students who are similarly at risk. Referring to the work of psychologist Madeline Levine, he writes:

Wealthy parents today, she argues, are more likely than others to be emotionally distant from their children while at the same time insisting on high levels of achievement, a potentially toxic blend of influence that can create "intense feelings of shame and hopelessness" in affluent children.

Stressed relationships of this kind may have a negative impact on character development. Riverdale's headmaster, Dominic Randolph, is concerned that students are lacking in important character traits.

Traditionally the purpose of a school like Riverdale is not to raise the ceiling on a child's potential achievement in life but to raise the floor. What Riverdale offers parents, above all else, is a high probability of nonfailure...The problem, as Randolph has realized, is that the best way for a young person to build character is for him to attempt something where there is a real and serious possibility of failure.

The book takes an interesting turn when, after focusing on a number of programs that measure their own success in terms of rates of college graduation, Tough reveals that he himself did not graduate from college. Clearly Tough is a highly successful person. This information led me to wish that more of the book had been devoted to exploration of the definition of success.

I thought of how Sigmund Freud defined mental health as the capacity to love and to work. I though about creativity and empathy as two qualities that are intimately tied to success. I found myself remembering Brandon Fisher, the manufacturer of drilling equipment who was recognized by President Obama in the 2011 State of the Union address for his critical role in the rescue of the Chilean miners.

These other aspects of success are mentioned in Tough's book. For example:

At KIPP, teacher Mike Witter explains to a parent, "The categories [of character traits] we ended up putting together represent qualities that have been studied and determined to be indicators of success. They mean you're more likely to to go to college. More likely to find a good job. Even surprising things, like they mean you are going to get married, or more likely to have a family."

A related body of research, coming from the fields of infant mental health and psychoanalysis, supports the notion that the way Tough interacts with Ellington will in fact lead to this broader definition of success. This literature, and in particular the work of leading researcher Peter Fonagy, refers to the central aspect of a secure attachment relationship, a capacity that is unique to humans, as mentalization, or "holding a child in mind."

John Bowlby, considered the father of attachment theory, writes how in the setting of such a relationship a child becomes, "self-reliant and bold in his exploration of the world, cooperative with others, and also- a very important point-sympathetic and helpful to others in distress."

Tough is applying his considerable talents as a journalist and writer to a critically important task. The question he asks is not only how children succeed, but also how the answer can inform meaningful social policy. He is bringing this issue to the forefront of public discussion. I am thrilled to be in the company of Tough, as in my work I have also been asking: What can we as a society do to promote healthy relationships, that in turn promote both character and success, from infancy through adolescence? Tough writes:

Parents are an excellent vehicle for those interventions, but they are not the only vehicle. Transformative help also comes regularly from social workers, teachers, clergy members, pediatricians, and neighbors.

Tough tackles this issue in his whole body of work, including not only this book, but also his first book, Whatever it Takes, about Geoffrey Canada and the Harlem Children's Zone, and his New Yorker article The Poverty Clinic about pediatrician Nadine Burke Harris' program. I am eager to see what he does next.

the baby connects

About Me

I am a pediatrician and writer with a long-standing interest in addressing children’s mental health needs in a preventive model. I have practiced general and behavioral pediatrics for over 20 years, and currently specialize in early childhood mental health. I am the author of The Developmental Science of Early Childhood:Clinical Applications of Infant Mental Health Concepts from Infancy Through Adolescence" ( 2017)"The Silenced Child:From Labels, Medications, and Quick Fix Solutions to Listening, Growth, and Lifelong Resilience" ( 2016) "Keeping Your Child in Mind: Overcoming Tantrums, Defiance, and other Everyday Problems by Seeing the World Through Your Child's Eyes"(2011) " I am on the faculty of UMass Boston Infant-Parent Mental Health Program, William James College, the Brazelton Institute, and the Austen Riggs Center.